ADMISSION APPLICATION
  1. STUDENT INFORMATION
  2. First Name(*)
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  3. Middle Name
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  4. Last Name(*)
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  5. Preferred Name or Nickname
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  6. Desired Entry Semester(*)
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  7. Desired Entry Year(*)
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  8. Applying for Grade(*)
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  9. Current Grade(*)
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  10. Gender(*)
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  11. Date of Birth (mm/dd/yyyy)(*)
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  12. Age(*)
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  13. Social Security # (xxx-xx-xxxx)
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  14. FAMILY INFORMATION
  15. Place a check next to the appropriate response: Parents are:(*)






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  16. If parents live separately, who has legal custody?
    Invalid Input
  17. Student lives with:(*)





    Invalid Input
  18. Parent1 Title(*)
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  19. Parent1 First Name(*)
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  20. Parent1 Middle Initial
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  21. Parent1 Last Name(*)
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  22. Parent1 Preferred Name or Nickname
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  23. Parent1 Home Street(*)
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  24. Parent1 Home City(*)
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  25. Parent1 Home State(*)
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  26. Parent1 Home Zip code(*)
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  27. Parent1 Name of Business
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  28. Parent1 Business Position
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  29. Parent1 Business Street
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  30. Parent1 Business City
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  31. Parent1 Business State
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  32. Parent1 Business Zip
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  33. Parent1 Home Phone (xxx-xxx-xxxx)(*)
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  34. Parent1 Business Phone (xxx-xxx-xxxx)
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  35. Parent1 Mobile Phone (xxx-xxx-xxxx)
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  36. Parent1 E-mail(*)
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  37. Is Parent1 a Pine School (St. Michael's) graduate?(*)
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  38. If yes, Class of
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  39. Parent2 Title
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  40. Parent2 First Name
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  41. Parent2 Middle Initial
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  42. Parent2 Last Name
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  43. Parent2 Preferred Name or Nickname
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  44. Parent2 Home Street
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  45. Parent2 Home City
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  46. Parent2 Home State
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  47. Parent2 Home Zip code
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  48. Parent2 Business Name
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  49. Parent2 Business Position
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  50. Parent2 Business Street
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  51. Parent2 Business City
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  52. Parent2 Business State
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  53. Parent2 Business Zip code
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  54. Parent2 Home Phone (xxx-xxx-xxxx)
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  55. Parent2 Business Phone
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  56. Parent2 Mobile Phone
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  57. Parent2 E-mail
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  58. Is Parent2 a Pine School (St. Michael's) graduate?


    Invalid Input
  59. If yes, Class of
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  60. Siblings names, ages and schools they attend:
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  61. SCHOOL HISTORY
  62. School presently or last attended(*)
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  63. School Street
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  64. School City(*)
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  65. School State(*)
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  66. School Zip code
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  67. School Phone (xxx-xxx-xxxx)
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  68. Reason for leaving
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  69. Describe the applicant's special interests and/or achievements, including academics, athletics, fine arts, etc.
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  70. Has the student ever been involved in any special tutorial classes, programs or activities to address social, physical, or academic challenges?(*)


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  71. If yes, please explain
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  72. Has the applicant been tested for or diagnosed with



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  73. Has the applicant had educational testing for any other learning differences or disabilities?(*)


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  74. If yes, please explain
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  75. Has the applicant ever been placed on probation, suspended or expelled from any school?(*)


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  76. If yes, please explain, including the name of the school and relevant details
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  77. REFERENCES/RECOMMENDATIONS
    For students applying to grades 2-12, enter below the name(s) of the applicant's current English and Mathematics teacher(s). If one individual teaches both subjects this year, also list the name of the applicant's teacher for the previous school year. The teacher(s) will be asked to complete student recommendation forms. The teacher(s) will be directed to fax or mail completed recommendation forms to the Admission Office. References are not required for applicants to the first grade or early childhood classes.
  78. Reference1 Name
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  79. Reference1 Address
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  80. Reference1 Telephone
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  81. Reference1 E-mail
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  82. Reference1 Relationship
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  83. Reference2 Name
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  84. Reference2 Address
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  85. Reference2 Telephone
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  86. Reference2 E-mail
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  87. Reference2 Relationship
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  88. PHOTO
  89. (Optional) Please attach a recent photo of the applicant.
    Invalid Input - Please check the file type and/or size.
    Accepted file extensions: .jpg (2MB File Size Limit)
  90. DIGITAL SIGNATURE
    By typing my name in the "Digital Signature" field, I pledge that the information contained in this application is truthful and accurate. I also grant permission for my child's present/former school(s) to release all necessary records and information to The Pine School.
  91. Digital Signature(*)
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  92. Digital Signature Date (mm/dd/yyyy)(*)
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  93. APPLICATION FEE - non-refundable application fee of $75
  94. Amount to be charged - Please enter amount without special characters, 75 for example.(*)
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  95. Cardholder's Name
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  96. Credit Card Type
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  97. Card Number
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  98. Expiration Date
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  99. Expiration Year
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  100. If you would like a copy of this submission, please put your email address in the field below.
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  101. Please enter these letters:
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  103. Please Note: Questions marked with an asterisk (*) are required.
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1300 East Tenth Street
Stuart, Florida 34996
Phone: 772-283-1222
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Hobe Sound, Florida 33455
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